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WALGREEN ARIZONA DRUG CO.
DSH030006 TUCSON MEDICAL CENTER
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Covered Entity Details
Entity Name
TUCSON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030006
Entity Address
5301 E GRANT ROAD
TUCSON, AZ 85712
Medicare Provider Number
030006
Participating Start Date
4/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN ARIZONA DRUG CO.
Pharmacy Address
DBA: WALGREENS # 05209
3180 N CAMPBELL AVE
TUCSON, AZ 85719
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bret Hicks, Director - Finance
(520) 324-1614
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2014
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